322 Blackwell Publishing Ltd Oxford, UK IJD International Journal of Dermatology 0011-9059 1365-4632 © 2008 The International Society of Dermatology XXX Correspondence Correspondence Correspondence Vulvovaginal-gingival lichen planus – a rare or underreported syndrome? We report a patient with vulvovaginal-gingival lichen planus (VVG-LP), a condition that is difficult to treat and is often underreported. Ideally, VVG-LP should be diagnosed before complications start to appear, as they present great morbidity and are very difficult to treat. 1 A 44-year-old white woman presented with a history of progressive manifestation, over a 1-year period, of cutaneous lesions on the hands, feet, and nails, hair loss, and erosions on the gingiva, tongue, and vulva. The lesions caused itching and pain. Over the last 3 years, she had experienced an irregular menstrual cycle, with long periods of amenorrhea, and complained of dyspareunia and postcoital bleeding. She was not using any form of contraception. The lesions on the palms and soles were erythematous and desquamative plaques with fissures, and the nails were dystrophic with anonychia (Fig. 1a). On the scalp, there were areas of scarring alopecia. She showed atrophic-erosive glossitis (Fig. 1b) and erosions on the gingiva and palate. Whilst examining the vulva, erosive mucous lesions were noted (Fig. 1c). Antinuclear antibody (ANA), anti-La, anti-Ro, and anti- DNA tests were negative. The follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and estradiol levels were normal. At the gynecologic examination, it was impossible to progress with the device into the vagina because of the presence of adhesions. Pelvic ultrasound was performed and found to be normal. The histopathologic examination of the scalp lesion showed a diffuse, band-like, lymphocytic infiltrate in the dermis (Fig. 2). Similar aspects were seen for the erosive tongue lesion (Fig. 2). Direct immunofluorescence showed subepidermal immunoglobulin M (IgM), IgG, C3, and fibrin deposition. Erosive LP was diagnosed. The patient was treated initially with clobetasol proprionate 0.05% solution for the oral lesions and oral prednisone 1 mg / kg for 2 months, with a partial clinical response. Subsequently, Figure 1 (a) Dystrophic nails and anonychia. (b) Atrophic erosive glossitis. (c) Red erosions and erythema in the labia minora International Journal of Dermatology 2009, 48, 322–324 © 2009 The International Society of Dermatology